Ten year old Noah has become vegetarian and is a very picky eater. He is willing to eat...

Ten year old Noah has become vegetarian and is a very picky eater. He is willing to eat only whole grains and refuses to eat legumes, seeds, and nuts. The mother wants to support her sons choice but is concerned since meat is a ready source of complete protein.

Questions

What should the mother include in Noah's diet to avoid deficiencies. What are the repercussions of such deficiencies?

Being a vegetarian does not have to be an unhealthy choice and, in fact, in this world where obesity is becoming commonplace, it is becoming a lifestyle choice of many. There are, however, considerations, especially for children and teenagers that a parent must be alert to. Calcium, iron and protein must be found from an alternate source of protein, other than meat and fish. Dairy is a good source of protein but some vegetarians do not consume dairy.

Iron and calcium should be supplemented from dark green, leafy vegetables, broccoli (Iron), wholegrains and eggs (iron and protein).

Legumes are high in fiber and iron and are a source of protein so Noah's mother should try and include small quantities of beans, lentils and peas and advise Noah that he needs to eat them if he is to stay healthy on a vegetarian diet. Similarly with nuts and seeds. Noah can have peanut butter to ensure his protein intake from nuts and seeds! Nuts and seeds also include iron and calcium so again Noah's mother needs to negotiate with him - even tiny portions that increase with time.

Noah's mother should take care to ensure adequate intake of vitamin B12 - a common problem for vegans who do not eat dairy, meat, fish or eggs. Noah is not vegan but as a picky eater it is essential that dairy and eggs form a good part of his diet as no plant sources contain vitamin B12. A smooth, thick, red tongue is indicative of a deficiency in vitamin B12. This could result in weakened bones, digestive tract problems and even memory loss is a possibility. If Noah tires easily, his mother should also check that he does not become anaemic - red blood cells carry oxygen to the heart - and so anaemia is problematical.

Children are growing and Noah will soon be a teenager. Adequate protein is necessary for building muscle tissue, repairing cells and so on. Noah should continue eating cereals - and some are fortified. Water is also essential as tiredness can come from dehydration and misdiagnosis is common.

Soya is considered a complete protein so it should be introduced to Noah's diet, especially due to his dislike for legumes, pulses and nuts. Large quantities of cheese are common in vegetarian diets so care should be taken with full fat varieties due to the saturated fat content.

To keep up iron levels, it would be an idea for Noah to eat food with a high vitamin C content simultaneously, such as strawberries, tomatoes, citrus fruits and broccoli.

Zinc could be a problem for Noah - white spots on the nails and recurring illnesses indicate poor immunity so he must eat sufficient wholegrains, nuts (as much as he can be persuaded)and soya products.